With
the state Legislature firmly in Democratic hands, single-payer health
care has never been closer to becoming a reality in New York state.

The New York Health Act would abolish private health insurance and replace it with a state-run system that would provide a health service to everyone in the state. While it has passed in the Assembly in previous years and has significant support in the state Senate, it is far from a done deal. Gov. Andrew Cuomo and lawmakers need more convincing that such a system could work at the state level. Lawmakers would also need to raise tens of billions of dollars to support such a program – and an unfriendly federal government cannot be counted on to help.

But if the New York Health Act were to become law,
it would revolutionize health care in the United States. No state has
ever successfully implemented a single-payer system at such a scale, but
the chairs of the Assembly and state Senate health committees say it
can be done. City & State caught up with Assemblyman Richard
Gottfried and state Sen. Gustavo Rivera to discuss the bills they are
sponsoring in their respective chambers and how they think the proposal
can make its way through the Legislature. These interviews have been
edited for length and clarity.

Richard Gottfried, Chairman, Assembly Health Committee

You’ve sponsored the New York Health Act for a long time, what’s different this year?

We’re
trying to coordinate our action on the bill with the state Senate. I
know they have talked about wanting to hold some hearings about the
bill, because for them it’s a newer topic than it is for the Assembly.
Hopefully, they will be able to do that early enough in the session that
both houses will be able to take the bill up before we adjourn in June.

If
the Legislature does not pass single-payer health care, do you think
there would be a voter backlash against progressives who ran on passing
it?

The bill has been scrutinized and picked at for many,
many years. I haven’t heard anybody asking questions about it that I
haven’t heard and answered for years, so it’s not like some new issue is
being unearthed. I don’t see any reason why elected officials who told
their voters they were for the bill wouldn’t bring it to the floor for a
vote.

Does New York need help from the Trump administration to make a single-payer system happen?

It would be simpler to implement the system with federal
cooperation. It would also save the federal government money. But there
are mechanisms for essentially wrapping around the federally subsidized
pieces of the health care system even if the feds won’t fully cooperate
in merging it into one program. With Medicare, there are a variety of
ways to handle the situation. One would be to have New York Health
operate essentially as a wraparound program to traditional Medicare.
Another mechanism would be for New York to create a giant Medicare
Advantage plan, that unlike other Medicare Advantage plans, would have
no cost sharing with patients, no restrictive provider network and would
offer the full range of benefits under the New York Health Act.
Similarly, with ACA subsidies, we may need to create a shell health plan
that would be the vehicle.

The
governor is proposing that a committee of experts figure out a universal
health care plan. Would that help or hinder your own effort?

This
proposal would create a commission made up of “health policy experts
and representatives of the insurance industry” – notice no reference to
representatives of health care providers or, more importantly,
consumers. This commission is just a gimmick for kicking the issue down
the road. There have been numerous studies and highly professional
analysis of the New York Health Act and similar proposals in other
states for years. We don’t need a commission. That’s the last thing we
need.

Gustavo Rivera, Chairman, state Senate Health Committee

The Assembly got a fast start on the New York Health Act. What about the state Senate?

We’re
going to be holding hearings on this bill. Our goal is to have them
right after the budget in different parts of the state. Gottfried has
had hearings before, but these would be bipartisan. I mean we will
invite Republicans to come if they want to, but I really meant that it
will be bicameral between the Assembly and the Senate. The commitment
that I make to folks who are interested in seeing this become a reality
is that there will definitely be some forward movement. I will make sure
that people understand what the bill is and what it is not, but I’m not
going to provide a timeline right now because I don’t have one.

The
latest version of the New York Health Act includes a new provision to
provide long-term care. How does this affect the overall size and cost
of single-payer health care?

The disability community and
the elderly community have been consistently telling us that it was
something we needed to do, but it certainly adds to the cost of the
overall plan. However, if I’ve said this once, I’ll say it a million
times: When you think about the costs of health care right now,
including long-term care, Medicare, Medicaid, private health insurance,
etc., you have a system that already costs $150 billion to $160 billion.
We believe if you put all these things together, it gives you a program
that will provide better results than the one we have now, and it will
cost less.

Could tax rates be set before passing the bill?

It’s
one of the conversations that we are having. One of the things that we
want to do is give give people some scenarios. Say “Bob” is a
62-year-old male self-employed accountant. How much is that person
paying for health care now? What kind of benefits does he have? I was
doing a panel just a couple of days ago in Riverdale and one woman said
she had actually done the math herself about how single-payer would
affect her. She was saying how much she had spent. She rolled out the
math and I’m like, “Holy Jesus, this woman did the math.” I want to use
her story and math to show the difference between what she has now and
what she would be paying if the single-payer passes.

WELCOME!

I represent Chelsea, Hell’s Kitchen, Midtown, and parts of Murray Hill and the Lincoln Center area in the State Assembly. I have been chair of the Assembly Health Committee since 1987. During off hours, I like to write Chinese calligraphy.